RESUMEN
BACKGROUND: Learning portfolios (LPs) provide evidence of workplace-based assessments (WPBAs) in clinical settings. The educational impact of LPs has been explored in high-income countries, but the use of portfolios and the types of assessments used for and of learning have not been adequately researched in sub-Saharan Africa. This study investigated the evidence of learning in registrars' LPs and the influence of the training district and year of training on assessments. METHODS: A cross-sectional study evaluated 18 Family Medicine registrars' portfolios from study years 1-3 across five decentralised training sites affiliated with the University of the Witwatersrand. Descriptive statistics were calculated for the portfolio and quarterly assessment (QA) scores and self-reported clinical skills competence levels. The competence levels obtained from the portfolios and university records served as proxy measures for registrars' knowledge and skills. RESULTS: The total LP median scores ranged from 59.9 to 81.0, and QAs median scores from 61.4 to 67.3 across training years. The total LP median scores ranged from 62.1 to 83.5 and 62.0 to 67.5, respectively in QAs across training districts. Registrars' competence levels across skill sets did not meet the required standards. Higher skills competence levels were reported in the women's health, child health, emergency care, clinical administration and teaching and learning domains. CONCLUSION: The training district and training year influence workplace-based assessment (WPBA) effectiveness. Ongoing faculty development and registrar support are essential for WPBA.Contribution: This study contributes to the ongoing discussion of how to utilise WPBA in resource-constrained sub-Saharan settings.
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Competencia Clínica , Evaluación Educacional , Medicina Familiar y Comunitaria , Lugar de Trabajo , Humanos , Estudios Transversales , Medicina Familiar y Comunitaria/educación , Evaluación Educacional/métodos , Femenino , Masculino , Sudáfrica , Aprendizaje , AdultoRESUMEN
BACKGROUND: Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised. AIM: This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme. SETTING: The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa. METHODS: This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach. RESULTS: Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities. CONCLUSION: Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning.Contribution: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa.
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Competencia Clínica , Medicina Familiar y Comunitaria , Humanos , Medicina Familiar y Comunitaria/educación , Sudáfrica , Médicos de Familia/educación , Lugar de TrabajoRESUMEN
BACKGROUND: Postgraduate supervision forms a vital component of decentralised family medicine training. While the components of effective supervisory feedback have been explored in high-income countries, how this construct is delivered in resource-constrained low- to middle-income countries has not been investigated adequately. AIM: This article evaluated supervisory feedback in family medicine registrars' learning portfolios (LPs) as captured in their learning plans and mini-Clinical Evaluation Exercise (mini-CEX) forms and whether the training district or the year of training affected the nature of the feedback. SETTING: Registrars' LPs from 2020 across five decentralised sites affiliated with the University of the Witwatersrand in South Africa were analysed. METHODS: Two modified tools were used to evaluate the quantity of the written feedback in 38 learning plans and 57 mini-CEX forms. Descriptive statistics, Fisher's exact and Wilcoxon rank-sum tests were used for analysis. Content analysis was used to derive counts of areas of feedback. RESULTS: Most learning plans (61.2%) did not refer to registrars' clinical knowledge or offer an improvement strategy (86.1%). The 'extent of supervisors' feedback' was rated as 'poor' (63.2%), with only 14.0% rated as 'good.' The 'some' and 'no' feedback categories in the mini-CEX competencies (p 0.001 to p = 0.014) and the 'extent of supervisors' feedback' (p 0.001) were significantly associated with training district. Feedback focused less on clinical reasoning and negotiation skills. CONCLUSION: Supervisors should provide specific and constructive narrative feedback and an action plan to improve registrars' future performance.Contribution: Supervisory feedback in postgraduate family medicine training needs overall improvement to develop skilled family physicians.
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Medicina Familiar y Comunitaria , Lipopolisacáridos , Humanos , Medicina Familiar y Comunitaria/educación , Retroalimentación , Aprendizaje , Médicos de Familia/educación , Competencia ClínicaRESUMEN
BACKGROUND: Clinical training is one of the roles of family physicians (FPs) in decentralised postgraduate training. Effective training requires skilled trainers and sufficient resources. Little is known about the resources available for decentralised clinical training in district health systems in low- to middle-income countries, especially in sub-Saharan Africa. AIM: To explore FPs' and registrars' perceptions of the available resources in a decentralised postgraduate family medicine (FM) training programme. SETTING: Five decentralised training sites affiliated with the University of the Witwatersrand across two provinces in South Africa. METHODS: This qualitative study forms part of a broader project evaluating a FM registrar training programme using the logic model. Semistructured interviews were conducted with a purposive sample of 11 FPs and 11 registrars. The interviews were transcribed verbatim and analysed thematically. RESULTS: Three themes were identified: 'Impact of resource constraints', 'Family physicians' skills and knowledge could be further improved' and 'Family physicians need additional support to optimise their training role'. The additional resources needed include more FPs, equipment, infrastructure and funding. Knowledge and skills of FPs were reported variable and needed further improvement. Additional support was required from peers, the district management and the university. CONCLUSION: Well-resourced decentralised training environments with sufficient skilled trainers and adequate resources are needed to positively influence FP training and supervision, especially in middle-income countries like South Africa.Contribution: Clinical trainers need adequate resources and support from peers, district management and the university for effective decentralised clinical training.
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Medicina Familiar y Comunitaria , Médicos de Familia , Humanos , Medicina Familiar y Comunitaria/educación , Sudáfrica , Universidades , Médicos de Familia/educación , Personal de Salud/educaciónRESUMEN
BACKGROUND: Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. The strong emphasis on workplace-based learning for speciality training makes it vital to gain in-depth insights into registrar supervision. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, however, little is known about the benefits and constraints of decentralised postgraduate supervision in low- to middle-income countries, especially in Africa. AIM: This study aimed to explore family physicians' and registrars' perceptions of the strengths and challenges of clinical and educational supervision across decentralised training sites. SETTING: The study was conducted across two provinces at five decentralised training sites affiliated with the University of the Witwatersrand, Johannesburg. METHODS: This qualitative study involved semi-structured interviews with a purposive sample of 11 FPs and 11 registrars. The data were thematically analysed. RESULTS: Two of the four themes identified, 'supervision is context-specific and supervisor-dependent', and 'the nature of engagement matters', involved strengths and challenges. The other two, 'supervision is not ideal' and 'the training environment is challenging', focussed on challenges. CONCLUSION: Supervisors and registrars described the postgraduate FM supervision as context-specific and supervisor-dependent. Supervisors displayed good clinical-teacher characteristics and supervisory relationships. However, several challenges, including registrars' workload, resource shortages and a lack of standardisation across training sites, need to be addressed. Regular faculty development is essential for supervisors to be aware of relevant aspects of, and current trends in, postgraduate training.
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Competencia Clínica , Medicina Familiar y Comunitaria , Medicina Familiar y Comunitaria/educación , Humanos , Médicos de Familia/educación , Investigación Cualitativa , SudáfricaRESUMEN
BACKGROUND: Several studies have been carried out on procedural skills of doctors in district hospitals in rural South Africa. However, there is insufficient information about skills of doctors in peri-urban district hospitals. This paper attempts to supplement this vital information. AIM: The aim of the study was to determine self-reported levels of competence in procedural skills of doctors in peri-urban district hospitals and to assess factors influencing this. SETTING: The study was undertaken in three district hospitals in two health districts of Gauteng Province. METHODS: A cross-sectional descriptive study using a self-administered questionnaire was undertaken in three district hospitals in two health districts of Gauteng Province. The questionnaire assessed procedural skills based on district health service delivery requirements for doctors in district hospitals using a modified skill set developed for family medicine training in South Africa. RESULTS: There was a wide range of self-reported competence and experience among doctors for various skill sets. Doctors were generally more competent for procedures in general surgery, medicine, orthopaedics, obstetrics and gynaecology and paediatrics than anaesthesia, ear, nose and throat and ophthalmology. There were statistically significant associations between age and overall anaesthetic competence (p = 0.03); gender and overall competence in surgery (p = 0.03), orthopaedics (p = 0.02) and urology (p = 0.005); years of experience and overall competence in dermatology skills; current hospital and overall competence in anaesthesia (p = 0.01), obstetrics and gynaecology (p = 0.015) and dermatology skills (p = 0.01). CONCLUSION: This was one of the first studies to look at self-reported procedural competence of doctors in a peri-urban setting in South Africa. The results highlight the need for regular skills audits, standardised training and updating of skills of doctors in district hospitals.
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Competencia Clínica/estadística & datos numéricos , Hospitales de Distrito , Hospitales Urbanos , Autoevaluación (Psicología) , Encuestas y Cuestionarios , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , SudáfricaRESUMEN
Background: Several studies have been carried out on procedural skills of doctors in district hospitals in rural South Africa. However, there is insufficient information about skills of doctors in peri-urban district hospitals. This paper attempts to supplement this vital information. Aim: The aim of the study was to determine self-reported levels of competence in procedural skills of doctors in peri-urban district hospitals and to assess factors influencing this. Setting: The study was undertaken in three district hospitals in two health districts of Gauteng Province. Methods: A cross-sectional descriptive study using a self-administered questionnaire was undertaken in three district hospitals in two health districts of Gauteng Province. The questionnaire assessed procedural skills based on district health service delivery requirements for doctors in district hospitals using a modified skill set developed for family medicine training in South Africa. Results: There was a wide range of self-reported competence and experience among doctors for various skill sets. Doctors were generally more competent for procedures in general surgery, medicine, orthopaedics, obstetrics and gynaecology and paediatrics than anaesthesia, ear, nose and throat and ophthalmology. There were statistically significant associations between age and overall anaesthetic competence (p= 0.03); gender and overall competence in surgery (p= 0.03), orthopaedics (p= 0.02) and urology (p= 0.005); years of experience and overall competence in dermatology skills; current hospital and overall competence in anaesthesia (p= 0.01), obstetrics and gynaecology (p= 0.015) and dermatology skills (p= 0.01). Conclusion: This was one of the first studies to look at self-reported procedural competence of doctors in a peri-urban setting in South Africa. The results highlight the need for regular skills audits, standardised training and updating of skills of doctors in district hospitals